Kasey Gaines iHuman (16-year-old weight loss)

The patient is a 16-year-old female with a progressive 20-pound weight loss over the last 6 months associated with food restricting, food preoccupation, excessive exercise, and subjective feelings of being overweight despite being severely underweight (BMI 15.7). Periods of restriction are interspersed with episodes of binging-eating and self-induced vomiting (two times per week on the average), as well as the use of laxatives for “constipation.” Other general health concerns include secondary amenorrhea and a recent metatarsal stress fracture. She reports tiredness, as well as a mild loss of interest in usual activities. Psychosocial stressors include striving for straight A’s; splitting of her family following parental divorce one year ago; and, social anxieties/phobias surrounding others’ perceptions of her weight. She is interested in entering the fashion industry. Physical findings are significant for orthostatic hypotension, dry skin and scalp hair, lanugo body hair, calluses of the dorsal aspect of the right hand, mild angular stomatitis, bilateral parotid enlargement, and secondary sexual development consistent with Tanner stage 4.